A few observations, as I am familiar with both the drugs and the key issues
here.

These dialysis patients are receiving these drugs intravenously, often three
times a week. This is not the normal administration method for these drugs,
which is subcutaneous injection (and a &^#%@! painful one at that). This is a
matter of convenience to the dialysis centers, as the patients are already
hooked up to the dialysis machine.

Additionally, these patients were receiving these drugs with Hemoglobin counts
already exceeding 13g/dl. This is higher than most insurance companies will
normally support, and clearly is pushing the limit for safety, as the studies
are showing.This is a matter of finance for the dialysis centers - and the
drug companies - as they make a profit for every dose given, apparently
whether the drugs were wisely given or not.

In the context of an patient on HCV antiviral therapy experiencing significant
anemia (HGB < 11g/dl) and properly administered and monitored,
Epogen/Procrit/Aranesp are extremely valuable from a health perspective, if
not a cost/benefit perspective (read the studies, you'd be amazed how
beneficial such interventions are - or how cheaply we are valued).

fwiw: I received 35 weeks of Epogen 60K IU, sub-cute, one shot per week. My
HGB rose from the depths of 8g/dl (which truly felt like Death's Door)  and
hovered around 10g/dl for 35 weeks, until two weeks after EoTX, when I had
finally made it above the 11g/dl cut-off point for my insurance. I tracked my
weekly blood work like a hound dog to make sure I didn't go seriously
macrocytic without anyone else noticing, but other than those fricken shots it
went fine.

There is no question I would have had at least a significant dose reduction -
to probably *both* Ribavirin and IFN, without the Epogen. Being 1b for 30+
years, A3/F2-3, and fifty-something, dose reduction is rarely a path to SVR...

Cheers

/greyhackles